Comparison of Clinical and Radiographic Outcomes Following Early Anterior Cruciate Ligament Reconstruction Versus Delayed Reconstruction for Skeletally Immature Patients Using a Physeal-Sparing Anatomical Double-Bundle Reconstruction Technique

TL;DR

This study compares early and delayed ACL surgery in children, finding similar clinical results but a higher rate of bone angle deformities with early surgery.

Contribution

The study introduces a modified physeal-sparing anatomical double-bundle ACL reconstruction technique for skeletally immature patients.

Findings

Clinical outcomes were good for both early and delayed ACL reconstruction groups.

Early reconstruction showed a 40% rate of angle deformities greater than 3°.

No patients had leg length discrepancies exceeding 10 mm.

Abstract

Purpose

In anterior cruciate ligament (ACL) injury among young patients, non-operative treatments are the common approach. However, meniscal and cartilage damage have been associated with this treatment, highlighting the need to explore surgical procedures for treating pediatric ACL injuries. We employed a modification of the hybrid physeal-sparing and anatomical double-bundle ACL reconstruction (ACLR) in skeletally immature patients. Here, we aimed to compare the clinical and radiographic outcomes, including International Knee Documentation Committee (IKDC) scores and growth disturbances, between early ACLR (ER) and delayed ACLR (DR) using our modified hybrid physeal-sparing anatomical double-bundle ACL reconstruction technique in skeletally immature patients.

Methods

Patients with an ACL injury with open physes following two techniques, were retrospectively included. The patients decided whether to select ER or DR. Patients who selected ER underwent surgery as early as possible. Patients who chose DR underwent conservative treatment and anatomical double-bundle ACLR after skeletal maturation. Clinical outcomes were described using the International Knee Documentation Committee Subjective Knee Form, the Tegner activity scale, and the Lysholm score. Using bilateral standing long-leg radiographs after skeletal maturation, growth disturbance was defined as a leg length discrepancy of >10 mm or varus or valgus angular deformity of >3° compared to the other leg. For the femur, three out of 10 patients (30%) had an angle deformity of >3°. For the tibia, one in 10 patients (10%) had an angle deformity of >3°.

Results

Sixteen patients, 10 (five boys and five girls) treated with ER and six (four boys and two girls) with DR, were analyzed. Clinical outcomes of both groups were good, and there were no significant differences. None of the patients had a leg length discrepancy of >10 mm. Four of the 10 patients (40%) had angle deformity of >3°.

Conclusions

Anatomical double-bundle ACLR using a hybrid physeal-sparing technique for skeletally immature patients revealed good clinical outcomes. Even though it was not associated with any symptoms, a relatively high rate of angle deformity was observed with ER.

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